Provider Demographics
NPI:1134121452
Name:FALCONE, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:FALCONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21327
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1327
Mailing Address - Country:US
Mailing Address - Phone:254-399-5400
Mailing Address - Fax:254-772-8669
Practice Address - Street 1:7125 NEW SANGER AVENUE
Practice Address - Street 2:STE A
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4054
Practice Address - Country:US
Practice Address - Phone:254-399-5400
Practice Address - Fax:254-772-8669
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1310207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX816582OtherBLUE CROSS
TX757679OtherFIRSTHEALTH
TX135729504Medicaid
TX4341278OtherAETNA
TX91916OtherSWHP
TX100346101OtherFIRSTCARE
TX109036004OtherUNITED HEALTHCARE
TX74178408876712A003OtherTRICARE
TX135729506Medicaid
TX816582OtherBLUE CROSS
TX816582Medicare PIN
060013503Medicare PIN
TX74178408876712A003OtherTRICARE
TX135729504Medicaid